AFFIRMATION

Utilization Management (UM) decision making is based only on appropriateness of care and service and existence of coverage. Innova IPA does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.

Innova IPA does not offer financial incentives to UM decision makers that encourage decisions that result in underutilization.

Our practitioners are ensured independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion, or
any other similar matters.

Members and Providers may request a copy of the criteria used in the decision-making process.

Utilization Management
(888) 975-3246

For information related to the following:
Quality and Utilization Management Programs A copy of the criteria used for a referral decision
UM Communications

Utilization Management Staff are available from 8:00 am –5:00 pm Monday through Friday to answer member and provider questions related to the authorization and referral processes. An After-Hour nurse is available to assist Members after normal business hours and on the weekends.